Session Title: Free Paper Session 20: Vitreoretinal Surgery V
Session Date/Time: Sunday 10/09/2017 | 08:00-09:30
Paper Time: 08:36
Venue: Room 117
First Author: : N.Wadhwa INDIA
Co Author(s): :
To describe the clinical characteristics, management challenges and surgical/visual outcomes of children presenting with rhegmatogenous retinal detachment (RRD) in tertiary care centres in India.
The study was restrospective interventional case series conducted in two tertiary care eye hospital in northern part of India.
Records of all the paediatric patients (<18 years of age) who presented with RRD over a period of 10 years were studied. Patients who were suffering from exudative retinal detachment or retinal detachment secondary to retinopathy of prematurity were excluded. Detailed charting was done of clinical characteristics of the patients like baseline best corrected visual acuity (BCVA), extent of retinal detachment, macular status and extent of proliferative vitreo retinopathy (PVR), lens status, IOP measurements and associated systemic anomalies if relevant. The patients were grouped and sub grouped according to risk factors leading to detachment, lens status, grade of PVR and BCVA. Surgical intervention consisting of standard vitreo retinal techniques which included scleral buckling or vitreous surgery alone or in combination. Surgical success was measured in terms of anatomical attachment and status of post operative visual recovery.
Records of 376 eyes of 320 children were studied in detail. Mean age of patients presenting was 9.2 +/- 5.6 years. The predominant sex of patients being male (65.3%). Most of the patients presented with poor visual acuity (<20/200) (n=196). The most common causes of RRD in our series were trauma and peripheral retinal degeneration. Iridofundal coloboma was the most common structural abnormality associated with RRD in our series. The detachment tended to be complex at presentation with majority having some form of PVR (n=240) and macula off status (n=290). Leucocoria was second most common cause of presentation in our patients(n=89). Retinal detachment was diagnosed on routine examination of fellow eye in 35 eyes. The mean number of surgeries required was 2.1 +/- 0.90 surgeries per eye (1-5). While 125 eyes underwent primary buckling, primary vitreous surgeries were required in rest of the cases with increasing PVR associated with primary vitreo-retinal surgeries (p<0.001). BCVA improved most in patients with no PVR or only posterior PVR. While 68% of eyes suffering from no PVR recovered ambulatory vision (>4/200), only 30% of eyes suffering from anterior PVR recovered ambulatory vision. Surgical success was higher in eyes where buckle was used along.
RRDs in children tend to present late with different clinical challenges as compared to adults in the form of extensive PVR and macula off status at presentation. Trauma and peripheral retinal degenerations are the most common predisposing factors leading to RRD with structural abnormalities also forming a major proportion of these patients. Combination of buckling and modern vitreo-retinal techniques allow us to achieve anatomical success in most of the cases though visual recovery is modest. The presence of anterior PVR and retinal shortening is a poor prognostic factor in terms of both the anatomical success as well as visual improvement.